[janfrn]

Wow! 20 weeks' orientation will be great! In our unit a new grad gets 16 weeks, and we're a quaternary care facility. You'll learn so much and have so many opportunities.

Virtually all PICU patients will have respiratory issues, so try to develop your skill at respiratory assessment. No big rush, since you'll be able to hone that once you actually get into the PICU. Take advantage of the RRTs' skill and knowledge; you'll be working with them closely.

Drug calculations are another huge thing for PICU nurses. You aren't expected to know standard dosages off by heart, just how to look them up, and you really must make it a practice to do that for all meds ordered for your kiddies if it isn't a unit policy. Remember that meds are always prescribed based on the patient's weight; you can do some practice calculations to help get used to it. Ancef 30 mg per kg per dose on a 17.7 kg patient for example. If you reconstitute the 1 gm vial with 10 mL of sterile water, the concentration will be 95 mg / mL. How much med do you draw up?

Review your shock states. It's not as important to know exactly what kind of shock you patient is experiencing as it is to recognize that they're heading that way. Treatment is slightly different for each one, but all involve fluid boluses and pressors. Understanding how each of the usual ones work will help you to understand why the one that's chosen was chosen.

If your unit sees a lot of cardiovascular patients, bone up on normal circulation and electrical conduction so you'll have an easier time recognizing the abnormal. Read a little bit about congenital heart defects, but don't get too caught up in them because they really are had to really "get" until you start caring for kids with them.

Review normal neuro exams for different ages. Some facilities don't have a separate Glasgow scale for infants, but they really should.

Those are the biggies. You'll learn what you need to know from your preceptors to provide safe care, and the stuff you learn will be building blocks for all the things you'll learn as you go. And remember why you're doing this... to help sick kids and their families!

[nursprl]

How about an 11 year old girl who was on vacation and ended up with a severe head injury after falling off a cliff. She ended up in the PICU for 6-8 weeks, intubated, ICP monitoring, craniotomy for severe head swelling, and neurological storming. We didn't think she would be back to normal; would have major deficits. We sent her home to NY for rehab and one year later, on her anniversary, her mom calls us up in our PICU to tell us how she was doing. Mom said she walks with a slight limp and a slur in her speech. This girl came onto the phone (we had speakerphone on), said hello to all of the nurses, and played her violin as if she was never in an accident. Listening to her play her violin 1 year after her accident brought tears to all the nurses eyes. I should mentioned she is a classically trained violinist before her accident and second chair in one of the orchestras in NY.

How's that for an inspiring story!

[googabin02]

Wow!! How inspiring! All you PICU "mommies" out there have such awesome experiences. Your replies are truly amazing...I can't wait to be a nurse and have stories to tell someday..and JanFrn...thanks so much for the help. You're a wealth of information...Sounds like maybe you should go into teaching?! Thank you! Keep em coming!

[janfrn]

Originally Posted by googabin02

and JanFrn...thanks so much for the help. You're a wealth of information...Sounds like maybe you should go into teaching?!

You're most welcome. I'm involved in our preceptorship program in the unit. I've mostly been partnered with nurses who have no critical care experience, which generally works out okay. I guess my enjoyment of teaching is showing because now I've got people I've worked with for years coming to me asking me to teach them how to do different things that they've just never had a chance to learn before. I've been researching my family tree and was stunned to find out that an ancestor that I had always though was a farmer was actually a teacher, so I must come by it that way!

[googabin02]

Haha...Maybe that's how..It's nice to know there are still nurses out there who enjoy teaching students or new graduates..Many of my experiences with clinicals during school were bad ones. Nurses always ask "Why are you going into nursing?" Or say we are crazy.. That really bothers me. It seems to me you are pretty good at what you do. Hopefully I get a preceptor with the same attitude as you!

[kate1114]

Here's a couple from my time in the PICU:

When I first started, one of my first patients was a child who had been in a horrific car wreck which killed most of his family. His survival was due solely to his seating in the vehicle. He arrived with multiple fractures and an extensive abdominal wound. During his first surgery, he began to crash so they stopped the procedure with sponges in his abdomen to help staunch bleeding, and left the abdomen open (covered with a sterile dressing). When he was more stable they actually completed the surgery in the unit. Since I was on orientation, I was able to watch it all. I really thought he didn't have much of a chance, and he was unstable for weeks, but he slowly got better. A couple of months later, he came to the unit on his way to be discharged home. He walked out the doors on his own. There was not a dry eye in the unit

Another story: a girl was riding horseback with her grandmother, and the girl was thrown off the horse and kicked in the chest. Luckily, the grandmother was a retired doc, so she gave rescue breaths until EMS came (also, the girl was wearing a helmet - yeah!!!!!!). She came in for surgery, wound up losing a small part of her lung. Was extubated and went to the floor within a couple of days after her chest tubes were out. She healed SO quickly compared to adults.

I think the key is the resilience of the kids and the thankfulness of the families. Certainly not all of them, but many of the PICU families I worked with really seemed to be thankful for our work and were such a joy to work with.

Good luck! Sounds like you have a great orientation set up!

[googabin02]

Thanks Kate! Sounds like you've seen some really interesting things! I can't wait to begin.. I have two months off from the time I graudate until my start day and although it will be nice to have a break, I'm really ready to jump right into it.

[Elvish]

Ok y'all, I'm not PICU but I've been reading this thread & boohooing!! I loved peds when I did it (now in mother-baby/nursery) and the reason I loved it was the reasons you all mentioned. Children's resiliency & families' gratitude. And even when they are sick, they are so darned cute!!

[KellieNurse06]

Hi googabin! I am a new nurse and also a parent of a frequent flyer to PICU......So I have the other side so to speak..lol..I am a home care nurse right now until I can get my foot in the door of a hospital.
I have great advice (I hope! ) from the parent/patient side of the coin......
My child is severly disabled and trached/vented ( vented last 2 years)
I guarantee you will have patients that are very very well known to the PICU...as my child & I am......to the point that you will know all the meds that kid is on without asking .....because you have cared for them so many times....
Words of advice from me.....don't EVER assume the parents don't have a clue or are in "denial" .....I had that done to me about 5 years ago by a highly educated ICU nurse & a critical care doc ......who knew me & my child all of 5 days (this wasn't our regular PICU , as ours had no beds open).....I just casually mentioned that I've been living this for many years so denial is hardly a description.......& it's very inappropriate as well.
Listen to the parents...they know their kids better than anyone else.
Don't ever judge a parent who isn't sitting at their kids bedside 24/7.........that may be the only break that parent gets from caring for their kid.....EVER. (trust me....personal experience)
Never assume because a kid can't communicate that they have no idea they even exist..........Many kids who are dd know whats going on around them but just can't openly communicate.
Just be there for the parents, even if it means rubbing their shoulder for a minute with your hand to let them know you are there for them.
I know we all judge at some point....heck I am even guilty of it myself...we are only human.....but just because they may not do something "by the book" or the way you would or "were taught in nursing school" doesn't make it bad or wrong.
Above all never assume anything .......I have this happen all the time......mostly by nurses & doctors.....that my kid lives in a facility......and when I casually say she lives home & always has.....I get a look like I have 10 heads attached to me.
Actually a week ago my child went for an endoscopy at the hospital we always go to...a big teaching one, and the nurse who 1st saw us in the holding area ( she was a grouch anyway) when we got there was just about yelling at me for "the paperwork from the facility" and the look on her face was like nothing I have ever seen before........ and I just asked what paperwork......... and she kept very loudly saying from the facility......and when I said she doesn't live in a facility...alll she did was hymn & haw when I was giving her all my kids meds, dosages etc....without even looking at a paper just rattling them off......doses, times, route etc......she stopped me 1/2 way through saying ok I have enough........I think she got my point.
Also another time I took her for a test & the nurse actually asked me (because our homecare nurse was with us) if I was learning how to take care of her (because I mentioned at the time I was going to nursing school when she asked what I did for work)...I looked at her as if to say "are you serious"...................
So I could go on & on & on......
Also you may see a miracle or two........my daughter is one....witnessed by all PICU staff..and even the doctor who had her literally looked up to the ceiling & said " someone or something of a higher power is watching over her because I have without a doubt witnessed a miracle with your daughter"
You see the summer of 2004 my daughter was literally dying and I mean literallly...from septic shock/multi organ failure etc ...you name it.......and she pulled through......even when we ended up just doing comfort care as nothing more could be done.......4 days 24/7 by her bedside & she miraculously pulled through.
To this day they talk about it........
So......I wish you luck on your PICU adventure........you will see many things good & bad.........and you'll be great! Please tell us all how it's going....I want to actually work in PICU myself at the hospital I usually take my child too because I am in awe at the way they work together & what incredible nurses they really are............ Good Luck!!!! Enjoy your new position!

[RNNPICU]

My PICU miracle story: There was this almost two year old child brought in ho basically had a vulvulus (sp) and whose gut had become almost completely necrotic, had gone to the OR, coded for 12 minutes (compressions, etc). had a lap and all they could do was put his gut in this sterile bag, and they waited to see if he could survive the night, he wasn't expected to, and they did not have much hope that if he coded again that we could resusitate him. So, I was doing ABGs Qhour, I watched his gut turn greener and greener in the bag, watched as his temperature went up, and as he began to clamp done, we had him on dopamine, versed, morphine. He survived the night, they resected his gut that next morning, he was still intubated when I had him the next night. Well, he eventually made it to the floor, is doing well, and is now up for a transplant (small bowel). But he was a true miracle.